World Neurosurg
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Case Reports
The valveless saphenous vein graft technique for EC-IC high flow bypass: Technical Note.
Extracranial to intracranial (EC-IC) high-flow bypass using radial artery or saphenous vein (SV) graft has remained vital for complex aneurysms. If an Allen test is positive, the radial artery cannot be harvested because of poor palmer collateral circulation. The valves are thought to be one of causes of SV graft failure. Herein we illustrate the "valveless SV graft technique" as bypass conduits. ⋯ The valveless SV graft technique is a useful technique in patients with complex ICA aneurysms who undergo EC-IC high-flow bypass with therapeutic ICA occlusion and whose Allen tests are positive.
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Rosai-Dorfman disease is a rare benign histiocytic proliferative disorder with a self-limiting clinical course. Skull base Rosai-Dorfman disease presents with intracranial lesions that often mimic meningiomas and other benign skull base tumors. The disease is difficult to diagnose radiographically, and tissue diagnosis exposes patients to significant perioperative risk. Surgical resection may require a large skull base exposure that risks significant surgical morbidity. Aggressive surgical resection, although often attempted, is of unproven efficacy. Our objective was to determine the optimal surgical management of skull base Rosai-Dorfman disease. ⋯ Tumors commonly occur in the sellar/parasellar region and result in loss of vision. Regardless of extent of resection, the majority of patients (>78%) have subsequent tumor regression or stable disease. Steroids and/or radiation are effective treatments for tumor recurrence. Tumor biopsy followed by observation, steroids, and/or radiation may be the most appropriate surgical management of skull base Rosai-Dorfman disease.
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Accurate frameless neuronavigation is highly important in cranial neurosurgery. The accuracy demonstrated in phantom models might not be representative for results in patients. Few studies describe the in vivo quantitative accuracy of neuronavigation in patients. The use of a frameless stereotactic drilling technique for stereoelectroencephalography depth electrode implantation in epilepsy patients, as well as diagnostic biopsies, provides a unique opportunity to assess the accuracy with postoperative imaging of preoperatively planned trajectories. ⋯ In this study, we showed that the in vivo accuracy of our frameless stereotactic drilling technique, suitable for stereoelectroencephalography depth electrode placement and diagnostic brain biopsies, was 3.5 mm.
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In light of recent reports of potential short- and long-term complications of bone morphogenetic protein (BMP) and increasing "off-label" use among spine surgeons, we wished to analyze online information on BMP and its controversial uses, as patients frequently search the Internet for medical information, even though the quality and accuracy of available information are highly variable. ⋯ Our study showed the ineffectiveness of the Internet in reporting quality information on BMP use. We found that websites authored by insurance companies provide an acceptable foundation for patient education. This, however, cannot replace the need for a thorough dialogue between doctor and patient about risks, benefits, and indications.
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Although prolactinomas are treated effectively with dopamine agonists, some have proposed curative surgical resection for select cases of microprolactinomas to avoid life-long medical therapy. We performed a cost-effectiveness analysis comparing transsphenoidal surgery (either microsurgical or endoscopic) and medical therapy (either bromocriptine or cabergoline) with decision analysis modeling. ⋯ On the basis of the results of our model, transsphenoidal surgical resection of microprolactinomas, either microsurgical or endoscopic, appears to be more cost-effective than life-long medical therapy in young patients with life expectancy greater than 10 years. We caution that surgical resection for microprolactinomas be performed only in select cases by experienced pituitary surgeons at high-volume centers with high biochemical cure rates and low complication rates.